Panchal Sameer, Gawhale Sangeet, Yadav Amit Kumar, Gupta Devanshu, Akshay K S
Department of Orthopaedics, Sir HN Reliance Foundation Hospital and Research Centre, Mumbai, 400004 India.
Department of Orthopaedics, Grant Medical College and Sir JJ Group of Hospitals, Mumbai, 400008 India.
Indian J Orthop. 2023 Jul 29;57(9):1443-1451. doi: 10.1007/s43465-023-00946-y. eCollection 2023 Sep.
Varus collapse is one of the pivotal mechanisms of failure following surgical fixation of proximal humerus fractures. The aim of the present study was to evaluate functional and radiological outcomes of non-vascularized fibular autograft as medial support with locking plate construct for comminuted proximal humerus fractures (PHF's).
We retrospectively evaluated 18 patients with unstable PHF's in the age group 50-70 years with a minimum follow-up of two years. All the fracture patterns were classified according to Resch, Neer's and AO classification and either medial calcar compromise or comminution were present in all. Open reduction internal fixation (ORIF) with a locking plate was performed for all the patients along with intramedullary fibular autograft to support medial calcar. Radiological outcome was assessed by neck-shaft angle (NSA) graded according to the Paavolainen grading method and difference in the humeral head height (HHH). Functional outcome was assessed by shoulder range of motion (ROM), University of California-Los Angeles (UCLA) score and American shoulder and elbow surgeons score (ASES).
Radiological union at the fracture site was achieved in all the patients at mean of 8 months (range 6-12 months). Range of movements were mean flexion of 123.89, extension 35.28, internal rotation 66.94, external rotation 57.78 and abduction of 115° at final follow-up. The average NSA was in the range of 120°-130° and none of the patients showed difference in HHH of ≥ 4 mm in the immediate post-operative radiograph and that taken on final follow-up. The functional outcome assessed by ASES score (mean 89.44) and UCLA score (mean 29.61) suggested fair to good results. None of the patients has shown varus collapse and avascular necrosis. Neither there were any complications related to the donor area.
In unstable proximal humerus fractures with calcar comminution or void, PHILOS plate fixation augmented with fibular autograft as a medial support reduces varus collapse and promotes early radiological union.
内翻塌陷是肱骨近端骨折手术固定后失败的关键机制之一。本研究的目的是评估非血管化腓骨自体骨作为内侧支撑并结合锁定钢板结构治疗粉碎性肱骨近端骨折（PHF）的功能和影像学结果。
我们回顾性评估了18例年龄在50至70岁之间的不稳定PHF患者，最短随访时间为两年。所有骨折类型均根据Resch、Neer和AO分类进行分类，所有患者均存在内侧距骨破坏或粉碎。所有患者均采用锁定钢板进行切开复位内固定（ORIF），并结合髓内腓骨自体骨以支撑内侧距骨。影像学结果通过根据Paavolainen分级法分级的颈干角（NSA）和肱骨头高度（HHH）的差异进行评估。功能结果通过肩关节活动范围（ROM）、加利福尼亚大学洛杉矶分校（UCLA）评分和美国肩肘外科医生评分（ASES）进行评估。
所有患者骨折部位均在平均8个月（范围6至12个月）时实现影像学愈合。末次随访时，平均活动范围为屈曲123.89°、伸展35.28°、内旋66.94°、外旋57.78°和外展115°。平均NSA在120°至130°范围内，术后即刻X线片与末次随访时X线片相比，没有患者的HHH差异≥4mm。ASES评分（平均89.44）和UCLA评分（平均29.61）评估的功能结果显示效果为中等至良好。没有患者出现内翻塌陷和缺血性坏死。供区也没有任何并发症。
在伴有距骨粉碎或缺损的不稳定肱骨近端骨折中，使用腓骨自体骨作为内侧支撑增强的PHILOS钢板固定可减少内翻塌陷并促进早期影像学愈合。
